Free AHM-530 Exam Dumps

Question 21

- (Topic 2)
The provider contract that the Danube Health Plan has with the Viola Home Health Services Organization states that Danube will use a typical flat rate reimbursement arrangement to compensate Viola for the skilled nursing services it provides to Danube’s plan members. A portion of the contract’s reimbursement schedule is shown below:
Home Health Licensed Practical Nurse (LPN): $45 per visit or $90 per diem Home Health Registered Nurse (RN): $50 per visit or $110 per diem
Last month, an LPN from Viola visited a Danube plan member and provided 1½ hours of home healthcare, and an RN from Viola visited another Danube plan member and provided 7 hours of home healthcare. The following statement(s) can correctly be made about Danube’s payment to Viola for these services:

A. Danube most likely owes $90 for the LPN’s skilled nursing services and $110 for the RN’s skilled nursing services.
B. Danube’s payment amount could be different from the amount called for in the reimbursement schedule if the level of care provided to one of these plan members was significantly different from the level of care normally provided by Viola’s RNs and LPNs.
C. Both A and B
D. A only
E. B only
F. Neither A nor B

Correct Answer:C

Question 22

- (Topic 2)
The following statement(s) can correctly be made about financial arrangements between health plans and emergency departments of hospitals:

A. These arrangements typically include payments for services rendered in the emergency department by a health plan's primary or specialty care providers.
B. Most of these arrangements are structured through the health plan's contract with the hospital.
C. Both A and B
D. A only
E. B only
F. Neither A nor B

Correct Answer:C

Question 23

- (Topic 1)
The Brice Health Plan submitted to Clarity Health Services a letter of intent indicating Brice’s desire to delegate its demand management function to Clarity. One true statement about this letter of intent is that it

A. creates a legally binding relationship between Brice and Clarity
B. most likely contains a confidentiality clause committing Brice and Clarity to maintain theconfidentiality of documents reviewed and exchanged in the process
C. prohibits Clarity from performing similar delegation activities for other health plans
D. most likely contains a detailed description of the functions that Brice will delegate to Clarity

Correct Answer:B

Question 24

- (Topic 1)
The provider contract between the Ocelot Health Plan and Dr. Enos Zorn, one of the health plan’s participating providers, is a brief contract which includes, by reference, an Ocelot provider manual. This manual contains much of the information found in Ocelot’s comprehensive provider contracts. The following statements are about Dr. Zorn’s provider contract. Select the answer choice containing the correct statement.

A. All statements in the provider contract shall be deemed to be warranties, because all statements of facts contained in the contract must be true only in those respects material to the contract.
B. Because the provider manual is part of the contract, Ocelot must make sure that its provider manual is comprehensive and up-to-date.
C. Because the provider contract is a brief contract, Ocelot most likely is prohibited from amending the contract unilaterally, even if it gives D
D. Zorn advance notice of its intent to amend the contract.
E. Areas that should be covered in the provider manual, and not in the body of the contract, include any specific legal issues relevant to the contract.

Correct Answer:B

Question 25

- (Topic 2)
The Aztec Health Plan has a variety of organizational committees related to quality and utilization management. These committees include the medical advisory committee, the credentialing committee, the utilization management committee, and the quality management committee. Of these committees, the one that most likely is responsible for providing oversight of Aztec's inpatient concurrent review process is the:

A. medical advisory committee
B. credentialing committee
C. utilization management committee
D. quality management committee

Correct Answer:C